1921
Volume 101, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Anemia is known to impact a child’s growth and development, but not all anemias are caused by iron deficiency, and the CDC and WHO have emphasized investigating other contributors to anemia. This cross-sectional sub-study of a 2012–2016 maternal-child cohort in coastal Kenya evaluated 244 children and found 185 (76%) to have been anemic on at least one time point since birth. At the time of assessment in 2016, evaluation included a complete blood count, nutritional assessment, and testing for parasitic infections, focusing on the primary outcome of anemia, defined as hemoglobin (Hb) < 11 g/dL. The average age at assessment was 20.5 ± 7 months. Ninety-five percent had a lifetime average Hb in the anemic range. Adjusting for age and gender, prior or current malaria infection (prior: Hb β = −0.99, 95% CI: −1.49 to −0.49, = 0.01), or having any current infection with hookworm, , , , and/or malaria (β = −0.84, 95% CI: −1.36 to −0.33, = 0.01) was associated with decreased current Hb. Nutritional evaluation revealed that children with a declining Hb ate fewer vitamin-A–rich vegetables per week ( = 0.01) or eggs ( = 0.01), drank more milk ( = 0.07), and ate more bread ( = 0.01), and were more likely to live in a household that experienced food shortage ( = 0.05). The high prevalence of anemia, polyparasitism, and dietary insufficiency among children in rural coastal Kenya suggests that remedial interventions will need to address both diet and parasitic infections to effectively combat this significant health threat.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Soliman AT, De Sanctis V, Kalra S, , 2014. Anemia and growth. Indian J Endocrinol Metab 18 (Suppl 1): S1S5. [Google Scholar]
  2. Fretham S, Carlson E, Georgieff M, , 2011. The role of iron in learning and memory. Adv Nutr 2: 112121. [Google Scholar]
  3. Grantham-mcgregor S, Ani C, , 2001. Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem a review of studies on the effect of iron deficiency on cognitive. J Nutr 131: 649668. [Google Scholar]
  4. Kassebaum NJ, 2014. A systematic analysis of global anemia burden from 1990 to 2010. Blood 123: 615624. [Google Scholar]
  5. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B, , 2009. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr 12: 444454. [Google Scholar]
  6. CDC, WHO, 2004. Assessing the Iron Status of Populations, 2nd edition. Geneva, Switzerland: World Health Organization. [Google Scholar]
  7. Friedman JF, Kanzaria HK, McGarvey ST, , 2005. Human schistosomiasis and anemia: the relationship and potential mechanisms. Trends Parasitol 21: 386392. [Google Scholar]
  8. Cojulun AC, Bustinduy AL, Sutherland LJ, Mungai PL, Mutuku F, Muchiri E, Kitron U, King CH, , 2015. Anemia among children exposed to polyparasitism in coastal Kenya. Am J Trop Med Hyg 93: 10991105. [Google Scholar]
  9. Bahizire E, Bahwere P, Donnen P, Tugirimana PL, Balol’ebwami S, Dramaix M, Nfundiko C, Chirimwami R, Mubagwa K, , 2017. High prevalence of anemia but low level of iron deficiency in preschool children during a low transmission period of malaria in rural Kivu, Democratic Republic of the Congo. Am J Trop Med Hyg 97: 489496. [Google Scholar]
  10. LaBeaud AD, 2015. Parasitism in children aged three years and under: relationship between infection and growth in rural coastal Kenya. PLoS Negl Trop Dis 9: 115. [Google Scholar]
  11. Calis JCJ, 2016. Severe anemia in Malawian children Malawi Med J 28: 99107. [Google Scholar]
  12. Asobayire FS, Adou P, Davidsson L, Cook JD, Hurel RF, , 2001. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infection: a study in Cote d’Ivoire. Am J Clin Nutr 74: 776782. [Google Scholar]
  13. Pullan RL, Gitonga C, Mwandawiro C, Snow RW, Brooker SJ, , 2013. Estimating the relative contribution of parasitic infections and nutrition for anaemia among school-aged children in Kenya: a subnational geostatistical analysis. BMJ Open 3: e001936. [Google Scholar]
  14. Clarke SE, Jukes MC, Njagi JK, Khasakhala L, Cundill B, Otido J, Crudder C, Estambale BB, Brooker S, , 2008. Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet 372: 127138. [Google Scholar]
  15. Cusick SE, John CC, , 2016. Iron, inflammation, and malaria in the pregnant woman and her child: saving lives, saving brains. Am J Trop Med Hyg 95: 739740. [Google Scholar]
  16. Smith JL, Brooker S, , 2010. Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review. Trop Med Int Health 15: 776795. [Google Scholar]
  17. Brickley EB, Spottiswoode N, Kabyemela E, Morrison R, Kurtis JD, Wood AM, Drakesmith H, Fried M, Duffy PE, , 2016. Cord blood hepcidin: cross-sectional correlates and associations with anemia, malaria, and mortality in a Tanzanian birth cohort study. Am J Trop Med Hyg 95: 817826. [Google Scholar]
  18. Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, Prashanth NS, Sudarshan H, Biggs BA, Shet AS, , 2010. Determinants of anemia among young children in rural India. Pediatrics 126: e140e149. [Google Scholar]
  19. Righetti AA, Adiossan LG, Ouattara M, Glinz D, Hurrell RF, N’Goran EK, Wegmüller R, Utzinger J, , 2013. Dynamics of anemia in relation to parasitic infections, micronutrient status, and increasing age in south-central Côte d’Ivoire. J Infect Dis 207: 16041615. [Google Scholar]
  20. Siegel EH, Stoltzfus RJ, Khatry SK, Leclerq SC, Katz J, Tielsch JM, , 2006. Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal. Eur J Clin Nutr 60: 228235. [Google Scholar]
  21. Stoltzfus RJ, , 1997. Rethinking anaemia surveillance. Lancet 349: 17641766. [Google Scholar]
  22. Sazawal S, 2006. Effect of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community based, randomised, placebo-controlled trial. Lancet 367: 133143. [Google Scholar]
  23. Moya-Alvarez V, Cottrell G, Ouédraogo S, Accrombessi M, Massougbodgi A, Cot M, , 2017. High iron levels are associated with increased malaria risk in infants during the first year of life in Benin. Am J Trop Med Hyg 97: 497503. [Google Scholar]
  24. Neuberger A, Okebe J, Yahav D, Paul M, , 2016. Oral iron supplements for children in malaria-endemic areas. Cochrane Database Syst Rev 2: CD006589. [Google Scholar]
  25. WHO, 2016. Guideline: Daily Iron Supplementation in Infants and Children. Geneva, Switzerland: World Health Organization, 44. Available at: http://apps.who.int/iris/bitstream/10665/204712/1/9789241549523_eng.pdf?ua=1. Accessed August 3, 2018. [Google Scholar]
  26. McKittrick ND, Vu DM, Malhotra IJ, King CH, Mutuku FM, LaBeaud AD, , 2017. Parasitic infections in pregnancy decrease placental transfer of anti-pneumococcal antibodies. Clin Vaccine Immunol 24: e00039-17. [Google Scholar]
  27. Malhotra I, Dent A, Mungai P, Muchiri E, King CL, , 2005. Real-time quantitative PCR for determining the burden of Plasmodium falciparum parasites during pregnancy and infancy. J Clin Microbiol 43: 36303635. [Google Scholar]
  28. Engorn B, Flerlage J, , 2015. The Hariet Lane Handbook, 20th Edition. Philadelphia, PA: Elsevier Saunders. [Google Scholar]
  29. Mcnamara DT, Thomson JM, Kasehagen LJ, Zimmerman PA, , 2004. Development of a multiplex PCR-ligase detection reaction assay for diagnosis of infection by the four parasite species causing malaria in humans. J Clin Microbiol 42: 24032410. [Google Scholar]
  30. Hermsen CC, Telgt DS, Linders EH, van de Locht LA, Eling WM, Mensink EJ, Sauerwein RW, , 2001. Detection of Plasmodium falciparum malaria parasites in vivo by real-time quantitative PCR. Mol Biochem Parasitol 118: 247251. [Google Scholar]
  31. Gamboa MI, Navone GT, Orden AB, Torres MF, Castro LE, Oyhenart EE, , 2011. Socio-environmental conditions, intestinal parasitic infections and nutritional status in children from a suburban neighborhood of La Plata, Argentina. Acta Trop 118: 184189. [Google Scholar]
  32. Malhotra I, Ouma J, Wamachi A, Kioko J, Mungai P, Omollo A, Elson L, Koech D, Kazura JW, King CL, , 1997. In utero exposure to helminth and mycobacterial antigens generates cytokine responses similar to that observed in adults. J Clin Invest 99: 17591766. [Google Scholar]
  33. Malhotra I, Mungai P, Wamachi A, Kioko J, Ouma JH, Kazura JW, King CL, , 1999. Helminth- and Bacillus Calmette-Guérin-induced immunity in children sensitized in utero to filariasis and schistosomiasis. J Immunol 162: 68436848. [Google Scholar]
  34. Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH, , 2013. Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area. Am J Trop Med Hyg 88: 433440. [Google Scholar]
  35. Coates J, Swindale A, Bilinsky P, , 2007. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access Indicator Guide. J Chem Info Mod 53: 16891699. [Google Scholar]
  36. Liu Y, De A, , 2016. Multiple imputation by fully conditional specification for dealing with missing data in a large epidemiologic study. Int J Stat Med Res 4: 287295. [Google Scholar]
  37. Benjamini Y, Hochberg Y, , 1995. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B 57: 289300. [Google Scholar]
  38. Liaw A, Wiener M, , 2002. Classification and regression by randomForest. R News 2: 1822. [Google Scholar]
  39. Malhotra I, Dent A, Mungai P, Wamachi A, Ouma JH, Narum DL, Muchiri E, Tisch DJ, King CL, , 2009. Can prenatal malaria exposure produce an immune tolerant phenotype? A prospective birth cohort study in Kenya. PLoS Med 6: e1000116. [Google Scholar]
  40. Food and Agriculture Organization of the United Nations, World Health Organization, 2001. Human Vitamin and Mineral Requirements: Report of a Joint FAO/WHO Expert Consultation in Bangkok, Thailand. Rome, Italy: FAO. Available at: http://www.fao.org/3/a-y2809e.pdf. Accessed January 28, 2018. [Google Scholar]
  41. Abrahams PW, Follansbee MH, Hunt A, Smith B, Wragg J, , 2006. Iron nutrition and possible lead toxicity: an appraisal of geophagy undertaken by pregnant women of UK Asian communities. Appl Geochem 21: 98108. [Google Scholar]
  42. Mathee A, Naicker N, Kootbodien T, Mahuma T, Nkomo P, Naik I, de Wet T, , 2014. A cross-sectional analytical study of geophagia practices and blood metal concentrations in pregnant women in Johannesburg, South Africa. S Afr Med J 104: 568573. [Google Scholar]
  43. Scott SP, Chen-Edinboro LP, Caulfield LE, Murray-Kolb LE, , 2014. The impact of anemia on child mortality: an updated review. Nutrients 6: 59155932. [Google Scholar]
  44. Tolentino K, Friedman JF, , 2007. An update on anemia in less developed countries. Am J Trop Med Hyg 77: 4451. [Google Scholar]
  45. Calis JCJ, van Hensbroek M, de Haan RJ, Moons P, Brabin BJ, Bates I, , 2008. HIV-associated anemia in children: a systematic review from a global perspective. AIDS 22: 10991112. [Google Scholar]
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  • Received : 30 Aug 2017
  • Accepted : 11 Mar 2019
  • Published online : 06 May 2019

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